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A 56-year-old man with a unilateral central scotoma
Digital Journal of Ophthalmology 2021
Volume 27, Number 3
September 27, 2021
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Khushali Shah, BA | University of Miami Miller School of Medicine, Miami, Florida; Bascom Palmer Eye Institute, Miami, Florida Benjamin J. Fowler, MD, PhD | Bascom Palmer Eye Institute, Miami, Florida Benjamin Lin, MD | Bascom Palmer Eye Institute, Miami, Florida Kara M. Cavuoto, MD | Bascom Palmer Eye Institute Jayanth Sridhar, MD | Bascom Palmer Eye Institute, Miami, Florida
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| Differential Diagnosis | Given the patient’s sexual history, placoid retinal lesion, classic OCT findings of EZ disruption with sub-RPE lesions, and seropositivity on laboratory studies, a diagnosis of acute syphilitic posterior placoid chorioretinopathy (ASPPC) was made.(3)
The differential diagnosis for this case includes viral retinitis, sarcoid, serpiginous retinopathy, serpiginous-like choroiditis, acute posterior multifocal placoid pigment epitheliopathy, acute macular neuroretinopathy, Vogt-Koyanagi-Harada syndrome, paraneoplastic retinopathy, and age-related macular degeneration. ASPPC can be distinguished from these conditions by its characteristic clinical and angiographic features, in particular, inflammation precisely delineated over a circular area of outer retina and inner choroid.(4) Importantly, ASPPC examination findings can overlap with various inflammatory ophthalmic conditions, and clinicians must first rule out infectious etiologies to avoid inappropriate treatment with systemic steroids. A study by Franco et al showed that antimicrobial treatment alone achieved complete ocular inflammatory recovery in patients with ASPPC, whereas a trial of corticosteroids provided no clinical benefit.(1)
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